April 2019 by San Diego Physician

APRIL 2019

Official Publication of SDCMS

San Diego County Medical Society Board of Director Candidates

invites you to

rendezvous

BY THE BAY

THURSDAY, MAY 23, 2019 6:00 PM-10:00 PM

PARADISE POINT RESORT, SUNSET DECK

Please join the San Diego County Medical Society for a sunset celebration as we welcome James H. Schultz, MD, MBA, FAAFP as SDCMS President for 2019, and thank David E. Bazzo, MD, FAAFP for his service as Immediate Past President.

Suggested Attire: Tropical Elegance, Black Tie Optional For additional information and to purchase tickets visit www.SDCMS.org/2019Rendezvous B

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APRIL

CONTENTS

VOLUME 106, NUMBER 4

Editor: James Santiago Grisolia, MD Editorial Board: James Santiago Grisolia, MD; David E.J. Bazzo, MD; Robert E. Peters, MD, PhD; William T-C Tseng, MD MARKETING & PRODUCTION MANAGER: Jennifer Rohr SALES DIRECTOR: Dari Pebdani ART DIRECTOR: Lisa Williams COPY EDITOR: Adam Elder OFFICERS President: David E. J. Bazzo, MD President-elect: James H. Schultz, MD Secretary: Holly B. Yang, MD Treasurer: Sergio R. Flores, MD Immediate Past President: Mark W. Sornson, MD, PhD GEOGRAPHIC DIRECTORS East County #1: Venu Prabaker, MD East County #2: Rakesh R. Patel, MD East County #3: Jane A. Lyons, MD Hillcrest #1: Gregory M. Balourdas, MD Hillcrest #2: Thomas C. Lian, MD Kearny Mesa #1: Alexander K. Quick, MD La Jolla #1: Laura H. Goetz, MD La Jolla #2: Marc M. Sedwitz, MD, FACS North County #1: Patrick A. Tellez, MD North County #2: Christopher M. Bergeron, MD, FACS North County #3: Veena A. Prabhakar, DO South Bay #1: Irineo “Reno” D. Tiangco, MD South Bay #2: Maria T. Carriedo, MD GEOGRAPHIC ALTERNATE DIRECTORS East County: Heidi M. Meyer, MD Hillcrest: Kyle P. Edmonds, MD Kearny Mesa #1: Anthony E. Magit, MD Kearny Mesa #2: Eileen R. Quintela, MD La Jolla: Wayne C. Sun, MD North County: Franklin M. Martin, MD South Bay: Karrar H. Ali, DO AT-LARGE DIRECTORS #1: Thomas J. Savides, MD; #2: Paul J. Manos, DO; #3: Alexandra E. Page, MD; #4: Nicholas J. Yphantides, MD (Board Representative to Executive Committee); #5: Stephen R. Hayden, MD (Delegation Chair); #6: Marcella (Marci) M. Wilson, MD; #7: Toluwalase (Lase) A. Ajayi, MD (Board Representative to Executive Committee); #8: Robert E. Peters, MD AT-LARGE ALTERNATE DIRECTORS #1: Karl E. Steinberg, MD; #2: Steven L-W Chen, MD, FACS, MBA; #3: Susan Kaweski, MD; #4: Al Ray, MD; #5: Preeti Mehta, MD; #6: Vimal I. Nanavati, MD, FACC, FSCAI; #7: Peter O. Raudaskoski, MD; #8: Kosala Samarasinghe, MD

feature

ADDITIONAL NON-VOTING MEMBERS Alternate Resident Physician Director: Zachary T. Berman, MD Alternate Retired Physician Director: Mitsuo Tomita, MD San Diego Physician Editor: James Santiago Grisolia, MD CMA Past President: James T. Hay, MD CMA Past President: Robert E. Hertzka, MD (Legislative Committee Chair) CMA Past President: Ralph R. Ocampo, MD, FACS CMA President: Theodore M. Mazer, MD CMA Trustee: William T-C Tseng, MD CMA Trustee: Robert E. Wailes, MD CMA Trustee: Sergio R. Flores, MD

6 San Diego County Medical Society Board of Directors Candidate Statements

departments

CMA TRUSTEES Robert E. Wailes, MD William T-C Tseng, MD, MPH Sergio R. Flores, MD

Briefly Noted: Calendar • Drug Prescribing/Dispensing • Public Health • Women’s Health

11 Time, Talent, and Treasure BY ADAMA DYONIZIAK

ADDITIONAL VOTING DIRECTORS Communications Chair: William T-C Tseng, MD Finance Committee Chair: J. Steven Poceta, MD Resident Physician Director: Trisha Morshed, MD Retired Physician Director: David Priver, MD Medical Student Director: Margaret Meagher

16 Wearable Medical Devices Give Abundant Data, and Risks

AMA DELEGATES AND ALTERNATE DELEGATES: District 1 AMA Delegate: James T. Hay, MD District 1 AMA Alternate Delegate: Mihir Y. Parikh, MD At-large AMA Delegate: Albert Ray, MD At-large AMA Delegate: Theodore M. Mazer, MD At-large AMA Alternate Delegate: Robert E. Hertzka, MD At-large AMA Alternate Delegate: Holly B. Yang, MD

BY MIRANDA FELDE, MHA, CPHRM

12 MACRA 2019 Changes Address Physician Concerns BY KIM HATHAWAY, MSN, CPHRM

18 Physician Classifieds

YOU Are Our Most Powerful Advocate

Trust: A Key Ingredient in Any Relationship

BY KATHERINE BOROSKI

BY HELANE FRONEK, MD, FACP, FACPh

APRIL 2019

Opinions expressed by authors are their own and not necessarily those of San Diego Physician or SDCMS. San Diego Physician reserves the right to edit all contributions for clarity and length as well as to reject any material submitted. Not responsible for unsolicited manuscripts. Advertising rates and information sent upon request. Acceptance of advertising in San Diego Physician in no way constitutes approval or endorsement by SDCMS of products or services advertised. San Diego Physician and SDCMS reserve the right to reject any advertising. Address all editorial communications to Editor@SDCMS. org. All advertising inquiries can be sent to DPebdani@SDCMS.org. San Diego Physician is published monthly on the first of the month. Subscription rates are $35.00 per year. For subscriptions, email Editor@SDCMS.org. [San Diego County Medical Society (SDCMS) Printed in the U.S.A.]

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APRIL 18: SDCMS Physician Mixer, 5:30– 8pm, BJ’s Restaurant and Brewhouse, La Mesa APRIL 27: Integrated Care Across the Lifespan Conference, Rady’s Children Hospital, Education Office Building APRIL 28–MAY 1: AAPC HEALTHCON, Las Vegas MAY 23: “Rendezvous by the Bay” SDCMS Gala, 6–10pm, Paradise Point Resort JUNE 30: Champions for Health’s Inaugural Soiree, “Awakening Wellness,” 5–8pm, Japanese Friendship Garden, Balboa Park

ADVOCACY: PUBLIC HEALTH

CMA Joins Legislative Effort to Reduce Consumption of Sugar-Sweetened Beverages THE CALIFORNIA MEDICAL ASSOCIATION (CMA) — which proudly represents over 44,000 physicians across all modes of practice and specialty — has joined the California Dental Association, health stakeholders, and legislators in support of a bill package aimed at reducing consumption of sugar-sweetened beverages. The legislation targets soda, energy drinks, sweet teas and sports drinks that contribute to obesity, diabetes, tooth decay, and heart disease, as well as ensures that The Coca-Cola Co. and PepsiCo Inc. stop targeting low-income communities and pay their fair share of public health costs. “Like the tobacco industry, companies like Coke and Pepsi are peddling harmful products to children at a significant cost to public health and our healthcare system,” says CMA President David H. Aizuss, MD. “These measures will help lower consumption and help Californians make healthier choices that prioritize public health.”

ADVOCACY: DRUG PRESCRIBING/DISPENSING

Security Prescription Fix Signed by Governor Newsom; Delays Implementation Until 2021 AFTER INTENSE lobbying from the California Medical Association (CMA), Gov. Gavin Newsom signed a bill on Monday that will end the confusion caused by flawed implementation of the state’s new prescription pad law. AB 149 will delay implementation of the new law until Jan. 1, 2021, ensuring that patients will continue to have access to the medicine they need while the state creates a system to better track prescriptions across the state. Physicians will be required to order a new set of prescription pads by that date, and the Department of Justice (DOJ) will determine the specs of those new pads sometime next year. In the meantime, physicians will be able to use pads obtained before or after Jan. 1, 2018. Both sets of pads will be accepted until DOJ can come up with guidelines are requirements for the new pads. “When AB 1753 went into effect, a timeline for

APRIL 2019

implementation was not established, which caused confusion and frustration for medical professionals and consumers alike,” Newsom wrote in his signing message. “AB 149 is needed to ensure patients throughout the state continue to receive their prescriptions quickly and easily while meeting the state’s need to aggressively address the opioid crisis.” “The governor’s action will ensure that patients can access the medicine they need and will erase the confusion between pharmacies, patients, and law enforcement that stemmed from the flawed implementation of last year’s law,” said CMA President David H. Aizuss, MD. “We want to thank lawmakers for acting quickly to address the concerns raised by patients and physicians, and we look forward to continuing to work with state lawmakers to address the state’s opioid crisis while ensuring patients who need medicine have the access they need.”

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TrusT

WOMEN’S HEALTH

New Title X Rules Will Limit Access to Critically Needed Care and Services for Millions of Patients THE TRUMP ADMINISTRATION issued a final rule last week that bars qualified family planning providers that provide abortions or abortion referrals from participating in the $286 million federal family planning program. The California Medical Association believes this rule will interfere with the physician-patient relationship, undermine established medical access, and prevent low-income people from accessing the full range of reproductive healthcare. The final rule also eliminates current requirements that Title X sites offer a broad range of medically approved family planning methods and nondirective pregnancy options counseling; and directs new funds to faith-based and other organizations that promote fertility awareness and abstinence as methods of family planning, rather than the full range of evidence-based family planning methods. Groups receiving money under the Title X program, which in California serves 1 million low-income women, were already prohibited from performing abortions with those funds. Under the new rule, federally funded family planning clinics must now maintain a “clear physical and financial separation” between services funded by the government and any organization that provides abortions or abortion referrals. Established in 1970, Title X is the sole federal program dedicated to funding family planning services for lowincome individuals. Title X supports the

delivery of family planning and related services including contraception, STD prevention and treatment, pregnancy tests, and life-saving cancer screenings. It plays a vital role in the nation’s public health safety net by ensuring that timely, safe, and evidence-based care is available to women, men, and adolescents, regardless of their financial circumstances. According to the Guttmacher Institute, more than $7 billion in taxpayer dollars are saved every year by preventing unintended pregnancies and by early treatment of breast and cervical cancer through Title X health centers nationwide. California’s Title X provider network is the largest in the nation — representing more than 25% of Title X patients nationwide. In California alone, $1.3 billion is saved annually thanks to public investment in family planning and related services provided at Title X-funded health centers. CMA believes this new rule will severely undermine the effectiveness of the Title X program. By reconfiguring who receives Title X funding, as well as the scope of family planning methods and services that those providers offer, these new regulations will limit access to critically needed care and services for millions of individuals who depend upon the Title X program for their care and will result in harm to patients and the public health. CMA submitted comments strongly opposing this rule when it was first proposed.

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SDCMS ELECTIONS: New Leadership for San Diego’s Medical Community

2019–20 SDCMS Board of Directors Candidates Note: • (inc.) After Name = Incumbent • Number in Parentheses (#) After Name = Term Length in Years

OFFICERS Candidate for President-elect: Holly B. Yang, MD, MSHPEd, HMDC, FACP, FAAHPM (1) I have been a member of the San Diego County Medical Society since I moved to San Diego 14 years ago. I have been on the board of directors since 2012, and have served on the executive committee for the past four years. I am past treasurer and current secretary of our organization. I am proud to represent San Diego County at the California Medical Association House of Delegates, and I serve as the chair of the Council on Membership, Governance, and Bylaws. I am also honored to represent you as an alternate delegate from CMA to the American Medical Association. With the ongoing uncertainty about healthcare, it is imperative that physicians are at the table. We must protect and expand access to high-quality healthcare for our patients, and our ability to provide and direct that care. I am proud to be part of SDCMS, an organization that represents physicians of all

APRIL 2019

specialties, all practice types, and all career stages. Together our diverse voices bring wisdom and passion to make a difference for the health of San Diego. Thank you for all the work you do to care for our community. Thank you for your trust to represent you. I ask for your continued trust and support for my candidacy as presidentelect of our SDCMS. Candidate for Secretary: Sergio R. Flores, MD (1)

I have served on the

SDCMS Board of Directors as both a Kearny Mesa alternate as well as geographic director. I am currently serving on the Executive Committee as treasurer. I would like to continue serving on the SDCMS Board as your secretary. I am currently on the CMA Board of Directors since 2012 as well as the current chairman of the CMA Finance Committee. I was recently appointed to the Board of IMQ as treasurer and chairman of the Finance Committee. I was born and raised in San Diego and graduated from SDSU in 1985. I graduated from the UCSF School of Medicine in 1989 and trained at UC Irvine in internal medicine and

gastroenterology from 1989 to 1994, and was board certified in both. I am in private practice and have been a partner at San Diego Digestive Disease Consultants since 1998. I serve on the Board of Sharp Community Medical Group for the past 20 years and currently serve on the executive committee as the vice president as well as the chairman of the Finance Committee. I served on the Sharp Healthcare Board of Directors from 2005 to 2012 and continue to serve on the Sharp Finance Committee. I would like to continue to offer my services to you and SDCMS. Thank you. Candidate for Treasurer: Toluwalase (Lase) A. Ajayi, MD (1)

I have had the honor of serving on the SDCMS board of directors for the past five years and on the SDCMS Executive Committee for the past two years. I consider it an honor to serve our medical community and I have the privilege to again ask for your support as I run for treasurer of SDCMS. I have

served as an SDCMS at-large director for the past four years, and joined the executive committee in 2017. I have been very active bringing the voice of the community physician and the patients we serve to the California Medical Association. Through my active involvement with SDCMS, I have represented San Diego physicians at the CMA, on the Council of Legislation, the Ethnic Minority section, the Young Physician section, and recently as the chair of the Council on Medical Services. I take these responsibilities seriously and work passionately in these roles because I believe that our San Diego County Medical Society provides a vital opportunity for our physician community to be able to speak as a singular “voice” to the public and to the politicians in the city, county, state, and federal government. We have seen our California Medical Board, the CDC, and CMS react to the opioid epidemic in ways that may not truly benefit the patients that we are trying to help and place restrictions on the practicing physicians. We have seen and continue to see the cost of medical education increase, leading to an increased debt burden on young physicians.

EHR interoperability and scope of practice continue to place a burden on the patientphysician-payer relationships. Given this reality, it will be critical that we as practicing physicians represent, with a unified voice, the medical care interests of our patients. I have worked to help our medical society speak with that united voice and continue to work on the ground to help ease these tensions and much more. I would truly appreciate your support as I seek reelection to the SDCMS board of directors.

GEOGRAPHIC DIRECTORS

physician, I consider defending the health of the public part of my mission, and the SDCMS Board more than helps me fulfill this mission. My past work on the Arizona and American Academy of Family Physicians boards, as well as my past experience as president of the San Diego Academy of Family Physicians board has been a great complement to this one. I also enjoy being a voice for the large group practice as I am employed by the Permanente Medical Group. Candidate for Hillcrest Director #1: Kyle P. Edmonds, MD (3)

Candidate for East County Director #1: Heidi M. Meyer, MD (inc.) (3)

My time so far serving on the SDCMS Board has been a wonderful reminder of the power physicians have to impact the health of our communities. I look forward to the opportunity to continue to work with the movers and shakers of organized political medicine in the state of California. As a family

I am a palliative medicine physician at UC San Diego and have been an active member of SDCMS since I moved to San Diego for fellowship six years ago. I’ve been an alternate member of the Board of Directors for five years and a member of the District I delegation to the California Medical Association House of Delegates. I am a past chair of the CMA Young Physician Section and a CMA delegate to the American

Medical Association House of Delegates where I also represent the American Academy of Hospice & Palliative Medicine in the AMA-YPS. I’ve been active in organized medicine since medical school and am honored to be nominated to be a voting board member of SDCMS. I look forward to continuing to serve as one of your representatives. Candidate for Hillcrest Director #2: Steve H. Koh, MD (3) Dear colleagues, I am honored to be seeking your support as Hillcrest Director for the San Diego County Medical Society. I am an associate professor in the Department of Psychiatry at UCSD, where I direct our Outpatient Psychiatric Services — Hillcrest, TeleMentalHealth, and Community Psychiatry Programs. I have been a member of CMA and SDCMS since my residency years when I was a YPS member and representative. I currently sit on CMA’s telemedicine committee. I have been active in the American Psychiatric Association, the California Psychiatric Association and the San Diego Psychiatric Society. I am passionate about mental health integration with primary care, technology innovations in medicine, community or public mental health, and collaborative partnerships for novel healthcare provider training. I believe that whole-person care can be ideally achieved by physician leadership in cross-professional treatment models and believe that we must mentor future colleagues to take a broad view of healthcare to push innovation and change. I would ask for your support to represent the Hillcrest area on the Board of Directors of SDCMS. Candidate for Kearny Mesa Director #1: Anthony E. Magit, MD, MPH (2) I appreciate the opportunity to continue my service on the SDCMS Board of Directors having been an alternate member of the SDCMS Board. Maintaining access to healthcare for our region’s children is a primary focus of my practice and advocacy activities. I currently serve on the CMA Council on Legislation and recently became the president of the Children’s Specialty Care Coalition (CSCC). The CSCC is a statewide organization representing physicians providing comprehensive medical and surgical care to children with special medical needs. My appreciation for the challenges SAN DIEGO PHYSICIAN.ORG

CANDIDATE STATEMENTS

facing medicine locally and nationally come from practicing pediatric otolaryngology for more than 25 years in San Diego and interacting with all of the health systems in our region. SDCMS has a critical role in supporting physicians representing the entire spectrum of medical practices in San Diego County. Candidate for North County Geographic Director #2: Christopher M. Bergeron, MD, FACS (inc.) (3) I am honored to be considered for a position on the SDCMS Board of Directors. I am a rhinologist/ otolaryngologist practicing at Scripps Clinic in La Jolla and Rancho Bernardo. Prior to joining Scripps Clinic, I was a member of the full-time faculty at UCSD. I am the immediate past president of the San Diego Academy of Otolaryngology and maintain voluntary faculty privileges at UCSD and the VA Medical Center in La Jolla. During my 10-plus years in the San Diego area, I have seen the impacts of increased governmental regulation on physicians and patients alike. I look forward to participating in the shaping of future healthcare policy at the local, state, and national level during my service with SDCMS, all the while keeping the interests of physicians and patients as the top priority.

AT-LARGE DIRECTORS Candidate for At-large Director #3: Irineo (Reno) D. Tiangco, MD (3) No Statement Provided Candidate for At-large Director #5: Stephen R. Hayden, MD (inc.) (3) For most of my career in the fields of emergency medicine and hyperbaric medicine at UC San Diego, I have been involved in national academic affairs. In addition to serving on the medical society’s Board of Directors, I have served as the District 1 Delegation Chair to the CMA. It has been a great privilege to participate in the annual House of Delegates, and to help determine the major topics the CMA will address each year. With the landscape changing so quickly in healthcare, I believe it is as important as ever for community physicians and academic physicians to partner and face the current challenges in medicine together. For over 20 years, I have been directly involved in national specialty societies and the American Board

APRIL 2019

of Emergency Medicine, and these experiences will allow me to contribute to SDCMS’s advocacy efforts. After a tour of duty as senior flight surgeon for the Naval Strike Warfare Center NAS Fallon, Nevada, I completed my emergency medicine residency at the University Medical Center at Stony Brook, New York, where I served as chief resident. I am the previous associate dean for graduate medical education at UC San Diego, after serving as the program director of the emergency medicine residency. I am a past president of the national Council of Emergency Medicine Residency Directors, and, in 2006, I was selected as the editor-in-chief of The Journal of Emergency Medicine. In 2005 I was the recipient of the American Academy of Emergency Medicine’s (AAEM) Residency Director of the Year Award and was recognized in 2005–2007 as one of America’s Top Physicians. In addition, I was fortunate to receive the American College of Emergency Physicians (ACEP) National Faculty Teaching Award. I am a primary author/editor for a major textbook in emergency medicine, The FiveMinute Emergency Medicine Consult, as well as numerous textbook chapters, peer-reviewed publications, and over a hundred invited na-

tional and international speaking engagements. I am married with three children and have a third-degree black belt in tae kwon do. I would consider it a privilege to continue to serve the San Diego County Medical Society and its members. Candidate for At-large Director #7: Karl E. Steinberg, MD, FAAFP (3)

I’m a family physician, geriatrician, and hospice physician, and I have been a nursing home and hospice medical director in coastal North County continuously since 1995. My passions are providing compassionate care to the frail elder population and others with serious or chronic illnesses, and helping to educate patients and healthcare providers about palliative care. In addition to patient care, I am a past chair of the Compassionate Care Coalition of California (the people who brought you POLST), and president-elect of CALTCM (the California Association of Long Term Care Medicine); I also currently serve on the government relations committee of

CAHF (the California Association of Health Facilities). I currently serve on the Leadership Council of the National POLST Program. I provide long-term care consulting and medicolegal services, I’m chief medical officer of Mariner Healthcare (a 20-facility California nursing home management company), and I’m medical director of two North County skilled nursing facilities (Life Care Center of Vista and Carlsbad by the Sea). I’ve been medical director of Hospice by the Sea in Solana Beach since 1995. I do home visits for complex case management patients for Scripps and have been an employed physician with Scripps Coastal and its corporate predecessors since 1990. I do a fair amount of speaking around town and at statewide and national meetings, mostly on topics of geriatrics, dementia, advance care planning, palliative care, bioethics, and medicolegal affairs. At SDCMS, I’ve been on the Bioethics Commission for over 10 years, on the Communications Committee for several years, have served as an alternate director on the BOD and a delegate for the CMA HOD since 2014, and have been chair of the San Diego Coalition for Compassionate Care, for which I still serve on the Executive

Committee. I’ve also contributed to a number of projects through Champions for Health, including the Alzheimer’s workgroup that created the AlzDxRx app and a recent CME webinar on opioids. I believe we have a long way to go in getting incentives aligned to optimize care (for example, taking care of ill nursing home residents in the nursing home instead of shipping them to the hospital), increasing awareness of palliative care and advance

care planning, and helping our patients get the care they want (and not get the care they don’t want). I’ve testified before several California Assembly and Senate committees about pending legislation on behalf of organizations I represent. By participating in organized medicine and the political process, I hope I can help move things along — with the assistance of many other committed individuals within SDCMS and other involved organizations. Thanks for

your support in allowing me to continue my service on this board.

AT-LARGE ALTERNATE DIRECTORS Candidate for At-large Alternate Director #1: Mark W. Sornson, MD, PhD (3)

It is a privilege to ask for your support to continue as an Alternate Board Member of SDCMS. I have served SDCMS as president in 2017–18, and am currently the immediate past-president. Previously I served five years as a representative on the Executive Committee, and as an at-large director for four years. I’ve been a CMA delegate or alternate delegate representing San Diego 10 years. For three years I was a member of the Insurance and Physician Reimbursement Reference Committee for CMA. I’m now serving on the CalPAC Board, the Council on Medical Services, and am chair of the CMA Subcommittee on Medicare. Through these experiences I have seen firsthand that when a medical society speaks with a unified voice and builds relationships, we can make a difference. When physicians come together, they are listened to. Rejoining the Board, I will continue to be a voice for reasoned discussion, representing all physicians. I’ve greatly enjoyed my service on

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CANDIDATE STATEMENTS

YPS DIRECTOR behalf of SDCMS and CMA, and I am honored to ask for your vote to continue. Candidate for At-large Alternate Director #2: Steven Chen, MD, FACS, MBA (inc.) (3)

It is an honor to be considered for re-election to a position on the SDCMS board of directors. As a surgical oncologist in independent practice with offices in Mira Mesa and Encinitas, I hold privileges in the Scripps, Sharp, and Palomar systems, allowing me to get a broad overview of county issues. Prior to my current practice, I have been an academic physician at UC Davis while serving as chief of breast surgery and an employed physician at City of Hope in Los Angeles. Through these different places, I have developed experience in multiple practice modes and will ensure that our policies and positions take all modes of practice into account. My experience in

APRIL 2019

organized medicine has spanned serving on the board of the Los Angeles County Medical Association and the Sierra Sacramento Valley Medical Society, as well as nationally including currently serving as the immediate past president of the American Society of Breast Surgeons, as well as prior service on the Governing Councils of the Young Physicians Section of the AMA and the Young Fellows Association of the American College of Surgeons. I continue to serve on the legislative committees of the American College of Surgeons and the American Society of Breast Surgeons and thus stay up to date on the issues facing the professional practice of surgery and medicine, while also serving as a delegate in the AMA House of Delegates, giving me a broader view of the needs of other specialties. I fully believe that if we do not defend our profession and act as professionals, we will lose the right to be a profession. SDCMS and organized medicine are key links to ensuring that being a physician continues

to mean being a professional. I ask for your support to allow me to help represent you and your concerns. Candidate for At-large Alternate Director #4: Albert Ray, MD (inc.) (3)

I humbly seek your support for re-election for a three-year term as At-large Alternate Director #4. Having served as past president of the SDCMS and as a CMA trustee, I feel I am well qualified to continue my service on the SDCMS Board of Directors. I am still engaged in the active practice of medicine in San Diego, and serve as president of Champions for Health as well as chair of the California Delegation to the American Medical Association. Also, I continue to teach medical students the art and science of medicine based on my experience as a practicing physician for over 40 years as a family physician. Thanks for your continued support and friendship.

Candidate for YPS Director: Obiora “Obi” Chidi, MD, MPH (1) I am both honored and humbled for the opportunity to serve as YPS Director. My introduction to SDCMS was as an RFS alternate during the last HOD. HOD was simply an exciting and enriching experience that resonated with my background as a government concentrator at Harvard, my master’s in public health and my desire as a developing new physician to help shape healthcare both for patients and physicians. I will be finishing my residency in emergency medicine at UCSD in June of 2019 and afterward will be practicing in the greater community of San Diego. As physicians we serve as advocates for our patients, the larger public, fellow physicians, and countless others. This reality is a special responsibility and often very challenging to balance. However, SDCMS has proven to be very diligent in tackling these issues and my desire is to continue this tradition.

AMA ALTERNATE DELEGATE Candidate for AMA Alternate Delegate: Mihir Y. Parikh, MD (inc.) (3) It is a privilege to ask for your support as I am now running for a three-year term as AMA Alternate Delegate. I have been on the SDCMS board for the past 10 years, holding various titles along the way from young physician delegate to county president. I have participated in numerous local and state advocacy events, fundraisers and membership drives. I have had the amazing opportunity to work with numerous other physician leaders in San Diego and in California on projects from running for elected office to educating the public on healthcare policy. I am currently serving on the CALPAC board as well. Thus, I think the next step would be to leverage all of this experience and represent San Diego physicians and the California delegation on a national level at the AMA. It is a time commitment to remain locally engaged as well as nationally involved, but I am motivated and highly interested, and I humbly ask for your support.

C H A M P I O N S F O R H E A LT H

Time, Talent, and Treasure By Adama Dyoniziak

APRIL IS VOLUNTEER Appreciation Month, and Champions for Health couldn’t achieve our mission without each and every single volunteer physician, nurse, medical interpreter, healthcare professional, and intern willingly giving their time, talent, and treasure. It really does take a village to create access to care for all and improve community health and wellness. “A great volunteer is invested and engaged in the mission of the organization,” says Andrew Gonzalez, Champions for Health’s volunteer coordinator. “If you want to get something done, get a busy person involved, which perfectly describes our volunteers. They make the time and find the resources to help our vulnerable populations.” Project Access San Diego is the conduit through which specialty physicians provide their services, procedures, and surgeries pro bono to uninsured San Diegans who are referred by participating clinics. “Project Access patients are so appreciative of the care they receive,” says Dr. Wendy Buchi, ob-gyn volunteer since 2010. “They want to improve their lives so they listen and follow through on their care, which is what every doctor wants to see from their patients.” The expertise of the physicians who volunteer is dependent on their talented team to make the magic happen. “Our whole clinic volunteers to see Project Access patients — we are happy to help,” says Dr. Kelli Karches, a volunteer endocrinologist since 2014, along with Dr. Gavin Jackson and Dr. Nadeen Hosien. Janice Symons, office manager for Drs. Arvind Saini and Howard Krausz, volunteer ophthalmologists since

Dr. Adam Fierer

Dr. Nathan Hammel

2016, adds, “We love volunteering for Project Access. I am lucky enough to work for two very kindhearted and civically minded physicians who lead by example when it comes to patient care.” Why do physicians decide to volunteer with Project Access? Gonzalez says that during volunteer surveys, themes have arisen. “It’s always a pleasure to volunteer with Champions for Health,” according to Gonzalez. “They love the Project Access patients. And volunteering with vulnerable populations reminds the physicians why they entered the field of medicine.” Dr. Nathan Hammel, a volunteer orthopedic surgeon since 2017, agrees. “I am happy to volunteer my time for Project Access patients. It gives me joy helping San Diegans get back to a normal life.” Concurring with him is Dr. Alberto Bessudo, volunteer hematologist since 2010. “Volunteering makes all the difference to the PASD patients,” he says. And the feeling of love and warmth is mutually felt by the PASD patients, according to Dr. Adrian Jaffer, volunteer rheumatologist since 2009. “I truly enjoy volunteering

for Champions for Health, and the patient thank-you cards are so heartwarming,” Dr. Jaffer says. In celebration of our Project Access volunteers, CFH has created a social media campaign. We are asking our volunteers to complete this statement: “I am a Champion for Health because … ” Submit responses with your photo to Charlie.Huettner@ ChampionsFH.org. Responses and photos will be posted on Facebook and Instagram from now until our Champions Soirée: Awakening Wellness event on June 30. For more information about the upcoming Champions Soirée, go to www.championssoiree.org. Those who would like to volunteer with Project Access, especially specialists in general surgery, gastroenterology, and cardiology, please contact Adama Dyoniziak at (858) 300-2780 or adama.dyoniziak@ championsfh.org. Ms. Dyoniziak is executive director of Champions for Health.

Dr. Buchi

SAN DIEGO PHYSICIAN.ORG 11

PAY E R M A N AG E M E N T/ R E I M B U R S E M E N T

MACRA 2019 Changes Address Physician Concerns By Kim Hathaway, MSN, CPHRM

APRIL 2019

CENTERS FOR MEDICARE & Medicaid Services (CMS) is taking steps to ease regulatory burdens by removing process measures, developing more outcome measures, changing the fee schedule to support telemedicine technology, and focusing on EHR interoperability. That’s because CMS listened to stakeholder input before releasing the final changes to the Quality Payment Program (QPP). The changes were effective on Jan. 1, 2019. This marks the third year of the QPP, which was established in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Highlights of the changes made to MIPS for 2019 include: 1. Category weights have changed for two categories. The category changes include: • Quality: 45 percent (down from 50 percent in 2018). • Cost: 15 percent (a 5 percent increase from 2018). 2. Important general MIPS changes for performance year 2019 include: • The performance period for the third year of the QPP/MACRA is the calendar year 2019. Performance for 2019 will affect payment in 2021. • The performance threshold increases in 2019 from 15 MIPS points to 30 MIPS points • The exceptional performance bonus increased to 75 points (up from 70 points in 2018). • The total amount of Medicare reimbursement at play for 2019/2021 has increased. • The five bonus points added to the final score of clinicians in small practices (TINs with fewer than 15 associated NPIs) increases to six points. • Eligibility has been adjusted to allow more clinician participation in MIPS, even by providers excluded based on the low-volume threshold criteria. • Eligible clinician types have expanded 3. The MIPS Quality category has: • Separated collection types from submission types. • Added eight and removed 26 measures. • Made claims-based measures available only to groups with fewer than 15 physicians.

4. MIPS Advancing Care Information category changed in 2018 to Promoting Interoperability. The Promoting Interoperability changes for 2019 include: • Four aims clinicians must meet: e-Prescribing, Health Information Exchange, Provider to Patient Exchange, and Public Health and Clinical Data Exchange. • Any unreported measure or no answers to a yes/no measure will result in a zero Promoting Interoperability score. • MIPS-eligible clinicians are required to use the 2015 Edition of Certified Electronic Health Record Technology (CEHRT) if they report in this category and must submit evidence to CMS. • The Promoting Interoperability reporting period will remain a minimum of a continuous 90-day period.

• Scoring is now solely based on performance and the base. • Security risk analysis is still required, but no points will be assigned. • Two new measures are added for the e-Prescribing objective. 5. MIPS Improvement Activities category changes include: • Removal of the 10 percent Promoting Interoperability bonus for using a CEHRT to complete the Improvement Activity. • Clarification of the criteria for “highweighted” classification. 6. MIPS Cost category changes include: • Eight episode-based Cost measures have been added. The same two core measures for Medicare Spending per Beneficiary and Total Per Capita Cost remain.

• All cost measures have the same weight. 7. Alternative Payment Models: More specialty-related models will be developed. Practices that find these changes overwhelming may want to reach out for expert help with industry-leading best practices to maximize Medicare payments. Visit Medical Advantage Group (medicaladvantagegroup.com) for more information. For resources on MACRA and success in optimizing reimbursement, go to MACRA Resources for Medical Practices (thedoctors.com/MACRA). Ms. Hathaway is a healthcare quality patient safety and risk consultant for The Doctors Company.

SAN DIEGO PHYSICIAN.ORG

A DVO C AC Y

YOU Are Our Most Powerful Advocate By Katherine Boroski

CRITICAL ISSUES affecting today’s physicians are being decided in the legislative arena at a fast and furious pace. Healthcare reform, medical liability, and scope of practice are just a few of the vital issues being debated and voted on by elected officials in Sacramento. The California Medical Association has some of the best lobbyists, lawyers, and other advocates in the Capitol, but the most powerful weapon in advancing the cause of physicians and their patients is you. Hearing from a physician with experience on the front lines of medicine can make all the difference for a legislator facing a complicated healthcare issue. That is why grassroots advocacy is so important. What Is Grassroots Advocacy? Grassroots advocacy is a “bottom up” approach to social change that utilizes real physicians from the community to shape public policy. Grassroots advocacy harnesses the power of effective one one-onone relationships multiplied over and over until a critical mass of support effectuates

APRIL 2019

the desired change. Effective advocacy is about communication and relationships. Advocacy must be an ongoing commitment and priority. Relationship building is essential and starts with persistence and repetition. Below are tips on how you can become an effective grassroots advocate on behalf of the physicians and patients of California. Recognize Your Power You are the subject matter expert on how healthcare issues impact your community. When it comes to matters of health, you are the specialist and the lawmaker is a generalist. Legislators don’t need to know everything you know about a particular issue — they just need to know enough to be convinced to take action. Engage Policymakers and Maintain Relationships Get to know your elected officials by meeting with them and attending events in the community and at the Capitol. Educate them about your issues and ask to be added

Connecting With Your Elected Official Through Social Media Social media is an excellent platform to communicate with your elected officials, especially Twitter. The key is to “tag” the elected official(s) you’re addressing using their official Twitter account. Keep in mind that many elected officials may have both a campaign Twitter account and an “official” Twitter account; the latter is preferred. With Twitter, you have only 140 characters to convey your message, plus an image or link. Try writing out your full message first, then review with a critical eye and pare down accordingly. Always keep it professional, even if you’re tweeting your opposition to a legislator’s bill. Most legislation can be viewed as either solving a problem — or creating one, depending on which side you stand. When tweeting in support of something, or to encourage a vote for something, make sure you’re stating WHY (i.e., the problem) and what you want the legislator to DO about it (i.e., the solution). Keep in mind that a legislator may not be familiar with all the bill numbers in a session, especially if they’re not the ones introducing that legislation. Any reference to legislation should be #hashtagged, with a very short description of the bill after. For example: As a practicing physician, I know how critical vaccinations are to prevent the spread of disease. @DrPanMD, vote YES on #SB277 #vaccinebill You can also sign up for the CMA Social Media Ambassador program, which provides training, advice, and content to help keep your colleagues and other medical professionals informed, connected, and engaged.

to their mailing or email lists for upcoming events. Volunteer for campaigns, attend fundraisers, and participate on advisory committees. Be the Resource Serve as an advocate on behalf of the physician community and your patients by offering your expertise and experience. Tell Your Story Tell policymakers your stories to illustrate the entire picture. There is power in sharing the realities of your profession. Share and Amplify on Social Media Increase public awareness by promoting your legislative advocacy on social media. If you meet with an elected official, post and tag photos on social media and promote with key groups and media. CMA Is Here to Help Available Resources: • CMA’s Legislative Hot List provides a summary and the status of CMAsponsored bills, as well as the progress of other significant legislation. • Real-time call-to-action alerts for legislative priorities. • Sample letters for advocating positions on legislation/regulations. • Sample telephone call scripts for calling Capitol offices to voice positions on legislative bills/issues. Other Ways to Get Involved • Text DocLobby to 52886 to sign up for text alerts and you will be immediately notified when we need you to take action. • Participate in CMA’s Legislative Advocacy Day, which is held annually in April. • Become a CMA social media ambassador. • Represent CMA by participating in media interviews for television, radio, newspapers, and podcasts. • Author op-eds to educate the public on health policy issues. • Become featured as one of our #CMAdocs. • Follow @doclobby on Twitter. Learn more at cmadocs.org/grassroots. Katherine Boroski is senior director of Strategic Communications at the California Medical Association. She can be reached at kboroski@cmadocs.org.

PLACE YOUR AD HERE Contact Dari Pebdani at 858-231-1231 or DPebdani@SDCMS.org SAN DIEGO PHYSICIAN.ORG

H E A LT H T E C H N O LO G Y

Wearable Medical Devices Give Abundant Data, and Risks

By Miranda Felde, MHA, CPHRM

SINCE 2013, the number of U.S. consumers tracking their health data with wearables has doubled.1 And that number continues to rise: During the third quarter of 2018, the wearables market saw a nearly 60% increase in earnings over the prior year.2 Wearables are electronic devices worn on the body, often like a watch. Wearables can track patient data like heart rate, blood pressure, or blood glucose. They can also track activity level, e.g., counting steps Promoters of wearables say that they could provide physicians with abundant data when caring for patients with chronic health issues. They also predict that combining wearables and gamification — e.g., competing with family members to see who can “score” the most steps in a day — may lead to improved health and better health outcomes. However, skeptics question whether gamification will really lead to healthier behaviors long-term. And questions abound

APRIL 2019

about what to do with wearables’ data and how to protect it. Wearables bring promise, but also real risks for patient safety and physician liability. Benefits of Wearables Promoters of wearables believe wearables will drive the transition to intelligent care, whereby physicians have access to more data — in which they can identify actionable components. Florence Comite, MD, a New York endocrinologist who describes wearables as “almost like magic,” uses data from wearables to tailor her interventions for patients with chronic conditions.3 Wearables can help patients take action, too. In one recent study, diabetes patients using a wearable app showed randomized controlled trial results comparable or superior to patients taking diabetes medications.4 Promoters of such digital strategies hope that they will encourage healthy behaviors

while requiring fewer office visits purely for monitoring purposes, thereby reducing healthcare costs while improving patient experience and engagement. For instance, David Rhew, MD, chief medical officer for Samsung, hopes that wearables can help patients move to the highest level of patient activation, Level 4:5 The Four Levels of Patient Activation • Level 1: Predisposed to be passive. “My doctor is in charge of my health.” • Level 2: Building knowledge and confidence. “I could be doing more.” • Level 3: Taking action. “I’m part of my healthcare team.” • Level 4: Maintaining behaviors, pushing further. “I’m my own advocate.” Some apps promote healthy behaviors with gamification.6 For instance, a user might compete with family or friends to take the most steps each day, either informally or through an organized group. Harvard

professor Ichiro Kawachi, PhD, wrote in JAMA Internal Medicine that this is “an opportunity for clinicians to turn health promotion into an engaging, fulfilling and fun activity.”7 Sponsors hope that such groups can promote accountability, responsibility, and mindfulness about activity and health conditions. Skepticism About Wearables It is too soon to say whether wearables will increase healthy behaviors and/or reduce office visits, thus lowering healthcare costs. Some studies have found that wearable devices have no advantage over other forms of goal tracking or social support in helping people meet their health and fitness goals.8 A 2016 study from the University of Pittsburgh, for instance, found that “young adults who used fitness trackers in the study lost less weight than those in a control group who self-reported their exercise and diet.”9 Risks of Wearables Though each device has its pros and cons, all wearables generate concerns for physicians, including: • Poor data quality: Data from wearables may or may not be reliable enough for medical use.10 • Data fixation: Patients may fixate on one number — steps per day, for instance — at the expense of other health variables, such as their diet, sleep habits, etc. • Lack of interoperability with electronic health records (EHRs): If a patient’s wearable cannot stream data to the patient’s EHR, then how can the physician’s practice securely acquire the data? • Data saturation: Physicians receiving patient data from wearables risk being soaked by a data fire hose.11Physicians need a plan and a process to determine what measurements are relevant to a given patient. • Unclear physician responsibilities for collecting, monitoring, and protecting data: HIPAA applies to patient data collected by physicians,12 but differing state laws mean that a physician’s specific responsibilities for monitoring and protecting patient data vary by location. • Lack of data security — and liability for physicians: Wearables are subject to cyberattack. In addition to presenting

obvious risks to patient safety, this may also present liability risks to physicians — who may be expected to notify patients of recalls issued for their wearables.13 Next Steps As more and more physicians are accepting — or requesting — their patients’ data from wearables, questions include: How can we tell when data from wearables is accurate? When it’s actionable? When it’s secure? Certainly, physicians interacting with data from wearables should independently confirm that data before changing a patient’s care, and should store data from wearables securely. For help implementing remote patient monitoring in your practice, see the American Medical Association’s (AMA’s) Digital Health Implementation Playbook. References 1. Donovan F. Despite patient privacy risks, more people use wearables for health. Health IT Security. Oct. 1, 2018. https://healthitsecurity.com/ news/despite-patient-privacy-risksmore-people-use-wearables-forhealth. Accessed Nov. 28, 2018. 2. Zaninello L. The wearables market is booming: Fitbit scares Apple and Google. Android Pit. Nov. 26, 2018. https://www.androidpit.com/ wearable-market-growth-fitbitscares-apple-and-google. Accessed Nov. 28, 2018. 3. Eramo L. Do doctors care about your wearable data? Future Health Index. Oct. 18, 2017. https://www. futurehealthindex.com/2017/10/18/ doctors-care-wearable-data/. Accessed Nov. 29, 2018. 4. Rhew D, panel moderator. Disruptive digital health technology. A4M MMI World Congress 2017. Dec. 14; Las Vegas, NV. 5. Ibid. 6. Spil T, Sunyaev A, Thiebes S, van Baalen R. The adoption of wearables for a healthy lifestyle: Can gamification help? 50th Hawaii International Conference on System Sciences. 2017 Jan 4-6; Waikoloa, HI. https://pdfs. semanticscholar.org/dacd/744f57cf95 51fe012884697e735a2a9cd3a8.pdf. Accessed Nov. 28, 2018. 7. Berg S. “To boost physical activity in patients, make a game of it.”

American Medical Association. Feb. 27, 2018. https://www.ama-assn.org/ delivering-care/public-health/boostphysical-activity-patients-makegame-it. Accessed Nov. 20, 2018. 8. Ross E. Weight loss on your wrist? Fitness trackers may not help. National Public Radio. Sept. 20, 2016. https:// www.npr.org/sections/healthshots/2016/09/20/494631423/ weight-loss-on-your-wrist-fitnesstrackers-may-not-help. Accessed Nov. 28, 2018. 9. O’Neill S. As insurers offer discounts for fitness trackers, wearers should step with caution. National Public Radio. Nov. 19, 2018. https:// www.npr.org/sections/healthshots/2018/11/19/668266197/ as-insurers-offer-discounts-forfitness-trackers-wearers-should-stepwith-caution. Accessed Nov. 28, 2018. 10. Piwek L, Ellis DA, Andrews S, Joinson A. The rise of consumer health wearables: Promises and barriers. PLOS medicine. Feb. 2, 2016. https://journals.plos. org/plosmedicine/article?id=10.1371/ journal.pmed.1001953. Accessed Nov. 28, 2018. 11. Donovan F. How does HIPAA apply to wearable health technology? Health IT Security. July 24, 2018. https:// healthitsecurity.com/news/how-doeshipaa-apply-to-wearable-healthtechnology. Accessed Nov. 28, 2018. 12. Ibid. 13. Carman SL, Umhofer RH. Wearable medical devices can raise issues for healthcare professionals. Healthcare Analytics News. October 30, 2018. https://www.hcanews.com/ news/wearable-medical-devices-canraise-issues-for-healthcare-professionals. Accessed Nov. 28, 2018. The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered. Ms. Felde is vice president of Patient Safety and Risk Management for The Doctors Company. SAN DIEGO PHYSICIAN.ORG

CLASSIFIEDS PHYSICIAN OPPORTUNITIES

SURGEONS NEEDED FOR EXPANDING NATIONWIDE SURGICAL PRACTICE FT/PT positions available. Competitive pay and flexible schedule with complete autonomy. Add revenue to your current practice. For more information, contact us: P: 1-877-878-3289 F: 1-877-817-3227 or email CV to: JOBS@ADVANTAGEWOUNDCARE.ORG www.AdvantageWoundCare.org UCSD, DEPARTMENT OF PEDIATRICS AND RADY CHILDREN’S HOSPITAL, CLINICAL POSITIONS AVAILABLE: The University of California, San Diego (UCSD) Department of Pediatrics (http://wwwpediatrics.ucsd.edu), and Rady’s Children’s Hospital of San Diego (http://www.rchsd.org ) is seeking clinicians to provide patient care at the Urgent Care Clinics of the Division of Emergency Medicine and Urgent Care. Clinicians should be board certified or board eligible in general pediatrics and have some experience in urgent care. The Urgent care has 5 centers located throughout San Diego County. We have full time and part time clinical positions available and see about 60,000 pts/ year. We have a great team of nurses, patient access reps and physicians and are looking for those who can work independently with excellent personal and clinical skills. UC beneﬁts are acknowledged to be among the ﬁnest in higher education. As UC Staff, you’ll enjoy comprehensive health and welfare plans protecting you and your family, an attractive pension, and optional retirement savings opportunities. Interested persons should contact Katherine M. Konzen, MD, MPH at 858966-8036. (Posted 2/28/2019) IMPERIAL RADIOLOGY - RADIOLOGIST NEEDED: Our Facility is an outpatient Diagnostic facility located in Imperial, CA and we are in search of a Part-Time/ Full-Time Radiologist. All candidates must have an active California Medical License. Pay to be determined. Please contact us at info@carlsbadimaging.com if this job is of interest to you. FAMILY MEDICINE PHYSICIANS NEEDED: Graybill Medical Group is one of North San Diego County’s largest independent multi-specialty groups with over 80+ physicians and advanced practitioners. We currently have FM openings in our Ramona and Valley Center locations (solo practices) 3-4 days/week and a full-time FM or IM opening in Vista . Current CA and DEA licenses required. Must be BC/BE. Conduct medical diagnosis and treatment of patients in an outpatient setting. Bilingual in English/Spanish helpful. We offer a competitive compensation and benefit package including malpractice coverage and shareholder opportunity. Check out a full list of our benefits under Careers at www.graybill.org. Send CVs to ssnodgrass@graybill.org, apply online, or fax (760)738-7101. FAMILY PRACTICE/INTERNAL MEDICINE PHYSICIAN NEEDED: Our company is looking for a board certified primary care physician. Time will be split between our La Mesa and National City locations. Hours are 8-5 Monday – Friday no night calls or weekend. Please email your CV to lara.encompass@gmail.com. (Posted 11/19/2018) CARDIOLOGIST POSITION AVAILABLE: Seeking a cardiologist to work part-time in an outpatient cardiology practice in North San Diego County. Practice opportunities from Mon.-Friday. Hours are from 8 to 5 p.m. There is no night calls, or holidays work days. The contracted cardiologist would decide from the days available which days to work. Please fax resume to 760.510.1811 or via e-mail at evelynochoa2013@yahoo.com. FAMILY PRACTICE MD/DO: Family Practice MD/ DO wanted for urgent care and family practice office in Carlsbad, CA. Flexible weekday and weekend shifts

APRIL 2019

available for family practice physician at busy, wellestablished office. FAX or email CV to (760) 603-7719 or gcwakeman@sbcglobal.net. PRACTICE OPPORTUNITY: Internal Medicine and Family Practice. SharpCare Medical Group, a Sharp HealthCareaffiliated practice, is looking for physicians for our San Diego County practice sites. SharpCare is a primary care, foundation model (employed physicians) practice focused on local community referrals, the Patient Centered Medical Home model, and ease of access for patients. Competitive compensation and benefits package with quality incentives. Bilingual preferred but not required. Board certified or eligible requirement. For more info visit www.sharp.com/sharpcare/ or email interest and CV to glenn.chong@sharp.com. FAMILY PRACTICE/INTERNAL MEDICINE PHYSICIAN NEEDED: Primary care physician wanted for established private practice in San Diego. La Jolla Village Family Medical Group has been caring for patients of all ages for 29 years in the UTC/La Jolla area of San Diego. We provide comprehensive preventive medicine, illness management, travel medicine, sports medicine, evidence-based chiropractic care, weight management, and more. Call responsibilities minor, hours consistent with a healthy work/life balance. Our office is modern, clean, and well appointed. Our staff is supportive, cohesive, and friendly. This a real family practice. Boardcertified, California licensed MD and DO physicians who are passionate about medicine and interested in this opportunity should send their CV and cover letter addressed to Tricia at officemanager@ljvfmg.com. Let us grow your practice according to your unique specialty interests and style. Responsibilities include: Provide excellent care, become part of a cohesive team, light call, maintain accurate and detailed medical records using HER, comply with all laws applicable to family practice/ internal medicine, including HIPAA, recommend lifestyle changes as appropriate to improve quality of life, Fulltime, Part-time. (Posted 8/16/2018) PHYSICIAN NEEDED: Family Practice MD. San Ysidro Health is looking for an MD for our Family Practice center. The Family Practice MD manages and provides acute, chronic, preventive, curative and rehabilitative medical care to patients and determines appropriate regimen in specialized areas such as family practice, prenatal OB/ GYN, pediatrics and internal medicine. Bilingual preferred but not required. Medical school graduate, CPR, CA MD and DEA License, board certified or eligible in primary care specialty. For more info on San Ysidro Health, visit: http://www.syhealth.org/ If interested, please email CV to Meagan.underwood@syhealth.org. DERMATOLOGIST NEEDED: Premier dermatology practice in beautiful San Diego seeking a full-time/ part-time BC or BE eligible Dermatologist to join our team. Existing practice taking over another busy practice and looking for a lead physician. This is a significant opportunity for a motivated physician to take over a thriving patient base. Work with two energetic dermatologists and a highly trained staff in a positive work environment. We care about our patients and treat our staff like family. Opportunity to do medical, cosmetic and surgical dermatology (including MOHs) in a medical office with state of the art tools and instruments. Please call Practice Administrator at (858) 761-7362 or email jmaas12@hotmail.com for more information. OUTPATIENT PRIMARY CARE OPPORTUNITY: San Diego Internal Medicine Associates (SDIMA) is looking for a strong MD candidate to join our 6 physicians and 6 physician assistants in providing excellent care in a private practice setting. SDIMA is a well-established office with board certified internists and med/peds physicians. No hospital call. Please send your CV, or any questions you may have to Jared.Kowerski@SDIMA.com. PRACTICE FOR SALE MEDICAL SPA AVAILABLE TO LICENSED PHYSICIAN: Southern California | Owner Benefit: $410,000 | This practice performs cosmetic procedures such as dermal fillers, Botox, and cosmetic laser treatments. The business has strong cashflow and is poised for continued growth. Minimal physician in-clinic time required and patients pay at time of service. Owner is retiring. A strong operations team will remain post acquisition. To see more (video interview with seller, assessment report, financials, etc.) visit: https://goexio. com/med-spa and select “Private Access” to sign an electronic NDA. Diligence materials available to qualified buyers only. Prefer a personal touch? Contact Bill Littlefield: (541) 429-2950. bill.littlefield@goexio.com.

FOR SALE, BUSY FAMILY PRACTICE-POTENTIAL URGENT CARE: Established family practice for 27 years located in Chula Vista near H Street at 805 in upscale mall setting. Ideal location with free and easily accessible parking. Spacious 2600ft office space with CLIA Certified Lab and X-Ray. Practice accepts and experienced in billing: Medicare, Tricare, Immigration Exams, DOT Certification, Workers Comp. Contact: S.J. Anderson 858-736-5818 or email marva.winchi.garcia@ gmail.com INTERNAL MEDICINE PRACTICE OPPORTUNITY: Internal Medicine practice in North San Diego County, Tri-City community, established for over forty years, available for full or part-time physician. This practice has an established EMR system, exceptional office staff and shares overhead with five other Internists. Inpatient activity available at your option. Please email:jalafata@ aol.com, or call North County Internal Medicine at 760726-2180. (Posted 1/14/2019). HIGHLY PROFITABLE MEDSPA NOW AVAILABLE TO LICENSED PHYSICIAN: Southern California | Asking Price: $1,050,000 | Cash Flow: $410,419 | This profitable and expandable company performs non-invasive cosmetic procedures, including dermal fillers, Botox, and laser treatments. Experienced staff plans to stay, and protects current physician/owner at 30 hours/ week max. If you’re ready to see online financials, a studio-quality video of their story, an industry-leading assessment, and more – visit: https://goexio.com/ med-spa-landing-sd for a summary. Interested? Click on “Private Access” to sign an instant nondisclosure and unlock the entire story. Full financials available on request. Prefer a personal touch? Contact Doug Miller: (208) 762-3451. doug.miller@goexio.com. PRACTICE AVAILABLE IN EL CAJON: Mature board certified Family physicians grossing $ 1 million per year are selling this practice in El Cajon, California. This is a busy practice , on the Allscripts EHR in a busy neighborhood and contracted with local IPAs. I will lease the 1500 sqft office condo to you as well. Send an inquiry to Dennis O Dominguez dd489583@gmail.com or send text to 619 2464548 and I will call you. PRACTICES WANTED PRIMARY OR URGENT CARE PRACTICE WANTED: Looking for independent primary or urgent care practices interested in joining or selling to a larger group. We could explore a purchase, partnership, and/or other business relationship with you. We have a track record in creating attractive lifestyle options for our medical providers and will do our best to tailor a situation that addresses your need. Please call (858) 832-2007. PRIMARY CARE PRACTICE WANTED: I am looking for a retiring physician in an established Family Medicine or Internal Medicine practice who wants to transfer the patient base. Please call (858) 257-7050. OFFICE SPACE / REAL ESTATE AVAILABLE

KEARNY MESA MEDICAL OFFICE - FOR LEASE 7910 Frost Street. Class A medical office building adjacent to Sharp Memorial and Rady Children’s hospitals. Suites ranging from 1,300-5,000 SF. For details, floor plans and photos contact David DeRoche (858) 966-8061 | dderoche@rchsd.org ENCINITAS OFFICE SPACE TO SHARE/SUBLEASE: Longstanding (38 years) allergist in Encinitas has a 3000 square foot office space available to share/ sublease. Six exam rooms and a permanent private office/consultation room. Office is available Tuesday morning and all day Wednesdays and Fridays. Office located on El Camino Real in Encinitas.Please contact wwpleskow@sbcglobal.net or call 760-436-3988. MEDICAL OR DENTAL SPACE AVAILABLE: For lease a medical or dental related practice or business in a small boutique office space located close to Moonlight Beach in Encinitas. First floor with 570 square feet and peek

ocean views. Available February 1st. Physician/Dentist parking spot comes with lease and lease would be until December 31, 2020. Sinks in 2 exam rooms, office space for physician/dentist and laboratory storage area in addition to lobby/reception area. Asking: $2,000/ month. Terms are negotiable. This will rent fast so hurry! Please contact: dana@sdrheumatology.com | (858) 6032068. (Posted 11/18/2018) SHARED OFFICE SPACE: Office Space, beautifully decordated, to share in Solana Beach with reception desk and 2 rooms. Ideal for a subspecialist. Please call 619-606-3046. OFFICE SPACE/REAL ESTATE AVAILABLE: Scripps Encinitas Campus Office, 320 Santa Fe Drive, Suite LL4 It is a beautifully decorated, 1600 sq. ft. space with 2 consultations, 2 bathrooms, 5 exam rooms, minor surgery. Obgyn practice with ultrasound, but fine for other surgical specialties, family practice, internal medicine, aesthetics. Across the hall from imaging center: mammography, etc and also Scripps ambulatory surgery center. Across parking lot from Scripps Hospital with ER, OR’s, Labor and Delivery. It is located just off Interstate 5 at Santa Fe Drive, and ½ mile from Swami’s Beach. Contact Kristi or Myra 760-753-8413. View Space on Website:www.eisenhauerobgyn.com. Looking for compatible practice types. OFFICE SPACE AVAILABLE: La Jolla (Near UTC) office for sublease or to share: Scripps Memorial medical office building, 9834 Genesee Ave-great location by the front of the main entrance of the hospital between 1-5 and 1-805. Multidisciplinary group and available to any specialty. Note we are in great need of a psychiatrist. Excellent referral base in the office and on the hospital campus. Please call (858) 455-7535 or (858) 320-0525 and ask for Sofia or call Dr. Shurman, (858) 344-9024. (Posted 8/10/2018) OFFICE SPACE FOR RENT: Multiple exam rooms in newer, remodeled office near Alvarado Hospital and SDSU. Convenient freeway access and ample parking. Price based on useage. Contact Jo Turner (619) 7334068 or jo@siosd.com. SHARED OFFICE SPACE AVAILABLE: Established orthopedic group seeks additional orthopedic surgeon for partnership or overhead sharing opportunity. Our office is centrally located in Kearny Mesa near Highway 163 and Balboa, easy access to freeways, affiliations with Sharp, Scripps. Extensive referral base, EMR/”paperlight” office, experienced MA/surgery scheduler/ referral coordinator. Please call Terry Sanchez, practice administrator, at (858) 278-8300 or email tsanchez@ synergysmg.com. (posted 11/19/2018) SCRIPPS ENCINITAS CAMPUS OFFICE: 320 Santa Fe Drive, Suite LL4 It is a beautifully decorated, 1600 sq. ft. space with 2 consultations, 2 bathrooms, 5 exam rooms, minor surgery. Obgyn practice with ultrasound, but fine for other surgical specialties, family practice, internal medicine, aesthetics. Across the hall from imaging center: mammography, etc and also Scripps ambulatory surgery center. Across parking lot from Scripps Hospital with ER, OR’s, Labor and Delivery. It is located just off Interstate 5 at Santa Fe Drive, and ½ mile from Swami’s Beach. Contact Kristi or Myra (760) 753-8413. View Space on Website: www.eisenhauerobgyn.com. Looking for compatible practice types. (Posted 4/4/2018) MEDICAL OR DENTAL SPACE AVAILABLE: For lease a medical or dental related practice or business in a small boutique office space located in the center of “Hillcrest/Bankers Hill”. Just renovated! The second story of this beautiful two story building is available for lease. A private gated entrance leads to a 1,139 square foot upstairs with 4 to 5 consultation rooms, waiting room with adjoining private deck and full bathroom. Additional security gate and mailbox. Separate address. Wood floors, refinished windows, natural light, quiet street, walkable to restaurants. On-site parking with up to 8 parking spaces available! Asking: $3,000/month. Terms are negotiable. This will rent fast so hurry! CLICK HERE for photos. Please contact: hillcrestofficerental@ gmail.com | (858) 775-5075 MEDICAL OR DENTAL SPACE AVAILABLE: For lease a medical or dental related practice or business in an office space with other medical offices located in downtown Chula Vista close to Scripps Chula Vista hospital. First floor with ~1000 square feet. Available January 1st. 2 physician/dentist parking spots comes with lease and lease would be until June 4, 2020 or longer should you negotiate with the building manager.

Sinks in 3 exam rooms, office space for physician/ dentist, bathroom, and laboratory area or additional exam room in addition to lobby/reception area. There is a long term subleasor on Fridays, so rent could be lower if you are willing to keep the subleasor, but asking: $2,000/month. Terms are negotiable. Please contact: dana@sdrheumatology.com | (858) 603-2068.

LA JOLLA (NEAR UTC) OFFICE FOR SUBLEASE FOR 2-3 DAYS PER WEEK

In the 4520 Executive Drive bldg. Excellent location between I-5 and I-805 . Beautiful renovated office space with 2 exam rooms and large physicians office for consultations. Ideal for Vein and vascular, primary care, pain management, physical therapy, rheumatology, infectious disease, dermatology, orthopedics. Interested parties, please email missyphilip@gmail.com

OFFICE SPACE / REAL ESTATE WANTED MEDICAL OFFICE SPACE SUBLET DESIRED NEAR SCRIPPS MEMORIAL LA JOLLA: Specialist physician leaving group practice, reestablishing solo practice seeks office space Ximed building, Poole building, or nearby. Less than full-time. Need procedure room. Possible interest in using your existing billing, staff, equipment, or could be completely separate. If interested, please contact me at ljmedoffice@yahoo.com. MEDICAL EQUIPMENT/FURNITURE FOR SALE HIGH TECH FACIAL IMAGING FOR SALE: New Reveal® Imager for sale. Ideal for MedSpa or cosmetic practice. The Reveal® Imager clearly demonstrates sun damage, brown spots, red areas and more. Create a personalized printed treatment record for the patient. Contact info@restoresdplasticsurgery.com or 858-2242281 if interested. MEDICAL EQUIPMENT AVAILABLE FOR DONATION: Carlsbad Imaging has medical equipment available for donation. Afinion HbA1c-Used, Siemens clinitek status+-Used, FastPack-Used. Please contact info@ carlsbadimaging.com if interested. (Posted 8/16/2018) NON-PHYSICIAN POSITIONS AVAILABLE POSITION AVAILABLE: This patient centered medical practice requires a skilled and professional individual with exceptional empathy, integrity, maturity and passion for patient care. You must have 5+ years of experience in the field as either an MA or LVN and be comfortable with front and back office work, be able to perform blood draws and injections, understand how to verify insurance, obtain prior authorizations, collect copays and balances. You are driven, diligent, organized, efficient, a clear communicator, honest and constantly wanting to improve. Please submit a detailed resume and 3 references from your last three positions to 92024medical@gmail.com. (Posted 11/19/18) PART-TIME, REMOTE MEDICAL CODING AND DATA ENTRY POSITION: Part-time, remote medical coding and data entry position available. All work is done remotely by logging into our EMR eclinical works. ICD-10 medical coding experience and familiarity with risk-adjusted diagnosis codes required. Experience with eclinical works a plus. Potential to increase work to fulltime possible. Please submit a letter of interest and your resume to docpaul@sdmedgroup.com. (Posted 11/19/18) NON-MEDICAL PROVIDER WANTED: San Diego Medical Group is a well-established and busy Internal Medicine practice. We seek an experienced NP to work independently as a primary care provider for our current NP’s patient panel who plans to leave the practice after 10 years for family needs. Work hours are Monday through Friday 7:30/8:30 AM to 4:30/5:30 PM. There is no call. After hours remote preparation for clinics and maintaining desktop duties (labs, imaging reports, consult notes, patient emessages, etc.) is required. Applicants must have prior experience in this capacity and be able to assume responsibility for patient care immediately. Patients range

from healthy adults to medically complex seniors. You must have experience providing medical care in Internal Medicine. In addition you need a DEA number, have familiarity prescribing Schedule II-V medications, be able to provide office gynecology, provide Tehehealth visits and perform basic dermatology procedures. Other duties may apply as deemed necessary. Spanish and/or experience with eClinicalWorks is a plus. Benefits include vesting into a 401k profit sharing retirement plan. Our office is located directly across the street from Scripps Mercy Hospital in the prestigious Mercy Building and we are staffed by two Internists and 8 additional staff. Salary $95,000$120,000 annually. Contact docpaul@sdmedgroup.com. (Posted 11/19/18) MEDICAL OFFICE MANAGER/CONTRACTS/BILLING PERSON: MD specialist leaving group practice, looking to reestablish solo private practice. Need assistance reactivating payer contracts, including Medicare. If you have that skill, contact ljmedoffice@yahoo.com. I’m looking for a project bid. Be prepared to discuss prior experience, your hourly charge, estimated hours involved. May lead to additional work. SEEKING PHYSICIAN ASSISTANT/NURSE PRACTIONERS: Graybill Medical Group is one of North San Diego County’s largest independent multispecialty groups with over 80+ physicians and advanced practitioners. The PA or NP will provide direct, in office patient care; this will include examination and treatment of patients and completion of all necessary paperwork. We currently have a FM part-time opening in our Ramona & Valley Center offices and a full-time Urology opening in Escondido. Prior Urology experience highly preferred. Must have a current CA (PA or NP) license, and be ACLS and CPR certified. Comfortable working independently. Bilingual in English/Spanish helpful. Send CVs to ssnodgrass@graybill.org or apply online at www.graybill. org, or fax (760)738-7101. SEEKING PART-TIME FM AND UROLOGY PHYSICIAN ASSISTANT/NURSE PRACTIONER: Graybill Medical Group is one of North San Diego County’s largest independent multi-specialty groups with over 80+ physicians and advanced practitioners. The PA or NP will provide direct, in office patient care; this will include examination and treatment of patients and completion of all necessary paperwork. We currently have a FM part-time opening in our Ramona office and a part-time Urology opening in Escondido. The Urology position is 2 days per week; preferably Mondays & Thursdays 8 am - 5 pm. Prior Urology experience highly preferred. Must have a current CA (PA or NP) license, and be ACLS and CPR certified. Comfortable working independently. Bilingual in English/ Spanish helpful. Send CVs to ssnodgrass@graybill.org or apply online at www.graybill.org, or fax (760)738-7101. PRODUCTS / SERVICES OFFERED CLASSICS OF MEDICINE LIBRARY AVAILABLE: The Friends of the San Diego Public Library are in search of a good home for a Classics of Medicine Library [Gryphon Edition]. These collectible volumes are leatherbound, facsimile reprints of classics from Hippocrates and Galen, through Virchow, Lister, and Jenner. The books are BEAUTIFUL! This particular collection contains 60 titles in total, all in like-new condition. A full list is available upon request. We are asking $550 and would prefer to sell them as a complete set. 100% of proceeds from our book sales support the programs and collections of the San Diego Public Library. Please call Lisa Heinz at (619) 572-1274 or email lis_heinz@hotmail. com for more information. DATA MANAGEMENT, ANALYTICS AND REPORTING: Rudolphia Consulting has many years of experience working with clinicians in the Healthcare industry to develop and implement processes required to meet the demanding quality standards in one of the most complex and regulated industries. Services include: Data management using advanced software tools, Use of advanced analytical tools to measure quality and process-related outcomes and establish benchmarks, and the production of automated reporting. (619) 913-7568 | info@rudolphia.consulting | www.rudolphia.consulting A VALUABLE EDUCATIONAL RESOURCE: Extensive Medical Articles File for sale. Charts, illustrations, articles. Emphasis on Emergency Medicine and Internal Medicine. Collected since 1973. Fills a large filing cabinet. (Cabinet not included.) Would make a useful gift for a medical student or resident. Best offer takes. Will accept offers for 30 days after the publication of this newsletter. View in person at a North County location by appointment. (858) 451-6517.

SAN DIEGO PHYSICIAN.ORG

P E R S O N A L A N D P R O F E S S I O N A L D E V E LO P M E N T

Trust: A Key Ingredient in Any Relationship By Helane Fronek, MD, FACP, FACPh

WE ALL HAVE PEOPLE whom we trust in our lives, and others whom we don’t. Yet, if asked why we don’t trust a particular person, we’re hard pressed to explain our feeling. Fortunately, in The Thin Book of Trust, Charles Feltman gives us a framework for looking at the components of trust that can illuminate what seems to be missing. According to Feltman, trust requires that we demonstrate four qualities: Sincerity (we say what we mean and we mean what we say); Reliability (we do what we say we will do); Competence (we have the ability to do what we say we will

APRIL 2019

do); and Care (we care about what the other person cares about). When we recognize that we don’t trust another person, reflecting on our interactions and experiences with them helps us identify which component(s) is missing. This then allows us to approach them with specific information and an invitation to address the gap. Conversely, if we realize that a person has demonstrated a lack of any of the components, we can explain that, because of their behavior, we are unable to trust them. The implications of losing another person’s trust may motivate

the person to change their behavior. Sadly, we often see a lack of trust develop when physicians transition into leadership roles. As we take on different roles we often become aware of other priorities. Budgetary, administrative, or legal considerations are disclosed to us, and what we care about begins to shift. Our former colleagues, who believed we would “have their backs,” are left feeling betrayed and abandoned. Being aware of the need to maintain and communicate a shared sense of care — I still care about what we all used to care about when I worked directly with you — can help physician leaders retain the trust of their clinical colleagues that is essential in creating alignment with the organization’s goals and directives. Trust is a crucial aspect of the doctor patient relationship as well. Unless our patients trust us, they will not feel safe or comfortable sharing their concerns and sometimes will withhold important information about their symptoms or behavior. This compromises our ability to discover the true diagnosis or manage their condition effectively. By insuring that we demonstrate these four components, we not only foster more fulfilling relationships, we will actually improve our clinical outcomes. As humans, we are all prone to breaking the trust of others. We may say something we don’t mean, promise something we are unable to provide, or fail to care about what another person cares about. In these instances, it is wise to address the loss of trust directly. As soon as we do, we take an important step toward regaining that trust. And, if we are to have any friendships in our lives, we each need to learn to forgive and be open to offering our trust again. By focusing on trust, we pave the way toward creating and maintaining the type of relationships that are essential to a happy and fulfilling life. Dr. Fronek, SDCMS-CMA member since 2010, is assistant clinical professor of medicine at UC San Diego School of Medicine and a certified physician development coach who works with physicians to gain more power in their lives and create lives of greater joy. Read her blog at helanefronekmd.com.

Tracy Zweig Associates INC.

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Position: Full-time and part-time. Full benefits package and malpractice coverage is provided by clinic. Requirements: California license, DEA license, CPR certification and board certified in family medicine. Bilingual English/Spanish preferred. Send resume to: hr@vistacommunityclinic.org or fax to 760-414-3702

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